Segregation is alive and well in the Commonwealth, at least in our medical assistance program. For the past 20 years in the Commonwealth, we have operated a segregated health care system under medical assistance, carving out behavioral health run at the county level but physical health overseen at the state level.

This has created unnecessary, artificial barriers to help our most vulnerable Pennsylvanians. According to a Seton Hall Center for Health and Pharmaceutical Law and Policy, “People with behavioral health conditions suffer from missed health care opportunities. Research has shown that people with serious mental illness suffer from increased burdens of sickness and early death as a result of poorly managed physical illness. People with less significant behavioral conditions too often remain unconnected to mental health or substance use disorder care because such services are unavailable in primary care settings. Clinicians responding to these system deficits advocate care integration through bringing primary care and behavioral health under one roof.”

In 2009, the American Psychiatric Association (APA) reaffirmed this in its behavioral health Position Statement of Carve-Outs and Discrimination. According to the APA, “A mental health managed care carve-out is created when benefits and services for people experiencing mental illness are administered and managed entirely separate from their standard health benefit package covering medical/surgical illnesses. It occurs when a separate entity manages the psychiatric benefit apart from the medical/surgical illness. It can also occur within a health insurance program when different rules and regulations discriminate against people seeking psychiatric care.”

The APA further points out, “Carve-outs, by segregating and segmenting the care of a specific group of patients, are inherently discriminatory. It has been pointed out that prior to the integration of the races, segregationists would point out the good that Southern schools achieved with segregation. However, such discrimination was not good, regardless of the quality of the schools. The same segregation of the mentally ill, although claimed to be good for some patients, is inherently not good, and often stigmatizes the patient with mental illness.”

Our health system faces a similar situation. Currently, mental health and drug and alcohol services provided via Pennsylvania’s managed care HealthChoices program differ from its physical health component. Unfortunately, a major barrier from the carve-out is the inability to engage providers in whole-person care. The Commonwealth’s cure of a segregated system discriminates against individuals in our mental health and substance abuse systems.

My legislation, House Bill 335, would address this issue while improving overall outcomes for patients through a more coordinated approach to treatment. By ending the inherent discriminatory practices our current medical assistance program, we will be able to remove barriers, both in the payment system but also in the policies which implement this archaic system which stigmatizes our most vulnerable citizens.

According to the Substance Abuse and Mental Health Services Administration, 68 percent of adults with mental illness have one or more chronic physical conditions which also require treatment. People with serious mental illness need integrated care, as they die on average 25 years earlier than those without. This is largely due to preventable chronic physical illness, complicated by the mental health and/or substance abuse.

The opioid crisis adds to the situation as addiction is often linked to physical and mental health issues. Addressing addiction necessitates actively coordinating a patient’s treatment, including physical health, pharmacy, mental health and substance abuse services. Right now, our medical assistance health care system does allow a primary care physician to know when their patient is in treatment for opioids. This means individuals in substance abuse can call in a prescription for opioids when they leave substance abuse treatment for an addiction to opioids. Not only did taxpayers waste thousands of dollars in treatment costs, but an individual with an addiction continues to have access to their addiction.

House Bill 335 would coordinate mental health, substance abuse and primary care services to produce the best outcomes and best care for people with such complex health needs. If we really want to improve health outcomes and reduce long-term costs within our taxpayer-funded medical assistance programs, it is imperative we integrate physical health and behavioral health. The discriminatory carve-out must end. Segregation wasn’t equal in our education system and it’s not equal today in our health care system.
I have spent my time in Harrisburg fighting the status quo and I will continue to do so especially when it means improving the quality of life for Pennsylvania residents. The sooner we end these segregated and discriminatory health care practices, the better our system of care will be in Pennsylvania.